Early coagulopathy is associated with increased incidence of ventilator-associated events among burn patients

Academic Article

Abstract

  • © 2016 by the Shock Society. Objective: Coagulopathy is known to be associated with burn injury. Our group has shown that, in spinal cord injury patients, coagulopathy is associated with an increase in ventilator-associated pneumonia (VAP). We hypothesized that the same association exists between coagulopathic burn patients and ventilator-associated events. Methods: Patients admitted for burn care between January 1, 2011 and December 31, 2015 who required mechanical ventilation were included in the study. Ventilator-associated events (VAEs) as defined by the Center for Disease Control were categorized as no event, ventilator-associated condition, infection-related ventilator-associated complication, and possible VAP. Demographic, injury characteristics were compared among four international normalized ratio (INR) categories using analysis of variance and chi-square tests. Results: Four hundred four patients were admitted for burn care, of whom 263 met the inclusion criteria. One hundred eleven had normal INR, 59 had a slightly elevated INR (1.2-1.4), 33 had a moderately elevated INR (1.4-1.6), and 60 had a severely elevated INR (>1.6). Those with moderately and severely elevated INR were ventilated for a longer period (P = 0.0034), had more days in the ICU (P = 0.0010), and had longer hospital stay (P = 0.0016). After adjusting for inhalation injury and total body surface area, patients with severely elevated INR were over four times as likely to have any VAE (OR: 4.16, 95% CI: 1.33-13.05) and 4.5 times as likely to develop infection-related ventilator-associated complication or possible ventilator-associated pneumonia combined (OR: 4.59, 1.35-15.67). Conclusions: Early coagulopathy is associated with a significantly increased incidence of VAEs in burn patients. While additional studies need to be conducted to verify these findings, early recognition and treatment could decrease VAEs.
  • Published In

  • Shock  Journal
  • Digital Object Identifier (doi)

    Author List

  • Younan D; Griffin R; Thompson M; Swain T; Honkanen M; Crosby JC; Ellis CV; Pittet JF; Kerby JD
  • Start Page

  • 107
  • End Page

  • 110
  • Volume

  • 47
  • Issue

  • 1